Urban Sprawl and Public Health

HEESOctober 4, 2001

Richard Jackson, M.D., M.P.H.National Center for Environmental Health

Howard Frumkin, M.D., Dr.P.H.Rollins School of Public Health

Agenda

1. Background: “Urban form” as a public health issue

2. Sprawl: a definition3. Health implications of sprawl4. A public health approach to sprawl

Background: Urban form as a determinant of public health

The Epidemiologic Transition of Cities

1. The Age of Pestilenceand filth

“As a rule, the streets are extremely dirty and offensive, and the gutters obstructed with filth. The filth of the streets is composed of house-slops, refuse vegetables, decayed fruit, store and shop sweepings, ashes, dead animals, and even human excrements….The reeking stench of the gutters, the street filth, and domestic garbage of this quarter of the city, constantly imperil the health of its inhabitants.”

Eleventh Ward Inspector, New York City, 1864

2. The Age of Industrialpollution

Pittsburgh, 1890

3. The Age of Social Pathology

The summer of 1967: 130 urban riots across the United States

All persist today

Manila

Port au Prince

But we can also identify…

4. The Age of UrbanSprawl

What is sprawl?

• Land-extensive, low density, leapfrog development

• Segregation of land uses• Extensive road construction• Architectural homogeneity• Economic and racial homogeneity• Shift of development and capital investment from

inner city to periphery• Absence of regional planning

A pattern of urban regional developmentthat features:

Sprawl: A Schematic

Suburban Development

Traditional Neighborhood

Land consumption: Changes in population and land area, selected metro areas, 1970-90.

-50

0

50

100

150

200

250

300

Cleveland Chicago New York Seattle L.A. PopulationLand Area

Source: Benfield et al., Once There Were Greenfields, NRDC and STPP, 1999.

Population Density:Selected Cities, 1997

Area (square miles)

Pop’n (in 000s)

Density (people/sq.

mile)

Washington 1,000 3,465 3,465 Boston 1,155 3,015 2,610 San Diego 755 2,610 3,455 Atlanta 1,790 2,580 1,440 Phoenix 1,090 2,400 2,200 Dallas 1,610 2,320 1,440

Population shifts:Suburbanization of the U.S., 1990-98

Travel patterns

Driving in Atlanta, 1997

Total Per Capita

Vehicle Miles Traveled (VMTs)/day

95,110,000 36.9

Hours of delay/year 136,590,000 52.9 Excess fuel consumed/year

214,000,000 82.6

Source: Texas Transportation Institute, 1999

How might sprawl affect health?

• ↑ air pollution• greenhouse gas emissions• ↑ heat island effect• ↓ physical activity• ↑ car crashes• ↑ pedestrian injuries• water quantity and quality• mental health consequences• ↓ social capital

Air pollution

Major pollutants of concern:

ozone leadNOx SOxCO air toxicsparticulates allergenshydrocarbons

Air pollution

Major pollutants of concern:

ozone leadNOx SOxCO air toxicsparticulates allergenshydrocarbons

Produced by cars and trucks

Ozone

Ozone health effects

• Respiratory effects:Airway inflammationDecreased air flowIncreased symptoms, ER visits, medication use, hospitalizations

• Cardiovascular effects:Increased mortality

• Immune effects:Increased susceptibility to infection

Greenhouse gas emissions

Total Per Capita

Vehicle Miles Traveled (VMTs)/day

95,110,000 36.9

Hours of delay/year 136,590,000 52.9 Excess fuel consumed/year

214,000,000 82.6

Excess CO2 produced/year

2.09 million tons

Source: Texas Transportation Institute, 1999

The Heat Island

Atlanta’s Heat Island: May 11, 1997

Source: NASA Marshall Space Flight Center

Health Consequences of Heat

• Heat syncope• Heat edema• Heat tetany• Heat cramps• Heat exhaustion• Heat stroke

INCREASING SEVERITY

Physical Activity

sprawl

• ↑ trip distances• ↑ vehicle trips• ↓ walking

↑ overweight↑ obesity

Want to take a walk?

Sedentary Lifestyle

Overweight / Obesity

•↑ overall mortality (2 to 3-fold)•↑ cardiovascular disease (3 to 5-fold)

The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking

Sources: Wei et al., JAMA 1999; Blair et al., JAMA 1996

•↑ risk of overall mortality (up to 2.5-fold in the 30-44 age group, less at older ages)•↑ risk of cardiovascular mortality (up to 4-fold in the 30-44 age group, less at older ages)•↑ risk of diabetes (up to 5-fold)•↑ risk of hypertension•↑ risk of some cancers•↑ risk of gall bladder disease

Source: Willett et al., New Eng J Med, 1999

Diabetes Prevalence, 1991-92

Diabetes prevalence, 2000

Car Crashes

Car crashes• Leading cause of deaths among persons

1-24 years old• Each year in the United States, motor

vehicle crashes account for:42,000 deaths3.4 million nonfatal injuries24 million vehiclesestimated $200 billion in costs

Source: NHTSA

Automobile fatality rates by city, 1998(excluding pedestrian fatalities; deaths/100,000/year)

New York 2.51San Francisco 3.76Philadelphia 5.36Portland 6.55Houston 9.80Phoenix 10.52Dallas 11.33Atlanta 13.12

Source: NHTSA

Pedestrian fatalities

Pedestrian fatality rates by city, 1998(deaths/100,000/year)

New York 2.33San Francisco 4.55Philadelphia 1.88Portland 2.58Houston 3.41Phoenix 4.09Dallas 4.28Atlanta 6.44

Source: NHTSA

Pedestrian fatalities

Pedestrian fatalities in Cobb, DeKalb, Fulton, and Gwinnett counties, Georgia, 1994-98, by race/ethnicity Race/Ethnicity Number Rate Black 140 3.85 White 117 1.64 Hispanic 40 9.74

Source: MMWR, 1999

Water quantity and quality• Quantity:

↑ runoff, ↓ groundwater recharge• Quality:

↑ non-point source pollution↑ siltation

Atlanta Journal-Constitution, May 13, 2000, p 1.

Mental Health

Road Rage• “driver behavior most people wouldn’t dream

of doing if they were face to face with another person” (Wisconsin DHFS)

• 1990-96: 51% ↑ rate of “events in which an angry or impatient driver tries to kill or injure another driver after a traffic dispute.” 10,000 reported incidents, 12,610 injuries, 218 deaths (AAA Foundation for Traffic Safety, 1997)

Self-reported aggressive driving behaviors (% respondents in each category)

Never Rarely Some-times Often

Say bad things to yourself about other drivers 15.3 22.9 39.5 22.1

Complain or yell about other drivers to a passenger in your vehicle 25.5 22.2 39.0 13.1

Give another driver a dirty look 41.8 17.6 32.7 7.7 Honk or yell at someone 61.1 17.9 17.9 2.9 Keep someone from entering your lane because you are angry 80.2 12.9 5.9 0.8

Make obscene gestures to another driver 83.7 9.2 6.1 0.8

Think about physically hurting another driver 89.0 5.4 4.4 1.1

Make sudden or threatening moves to intimidate another driver 94.6 4.0 1.1 0.1

Follow or chase another driver in anger 96.5 3.2 0.3 0.0

SOURCE: Mississippi State U., 1999 National Highway Safety Survey. January, 2000.

Social capital

Social capital defined as:• Social networking and engagement• Trust and reciprocity

Sprawl and social capital• More driving time means less time with

family, friends, and civic organizations.

• Putnam: every 10 minutes of commute time means a 10% decline in social capital

• Suburban voters tend to favor more individualized, less collective solutions.

• Residential stability across the lifespan: The need for elders to change neighborhoods.

• Aggravated income inequality?

Sprawl and income inequality

Sprawl and income inequality

Health implications of sprawl: Summary

• ↑ air pollution• greenhouse gas emissions• ↑ heat island effect• ↓ physical activity• ↑ car crashes• ↑ pedestrian injuries• water quantity and quality• mental health consequences• ↓ social capital

Solutions

Atlanta Journal-Constitution, May 12, 2000, May 17, October 30, 2000

Smart Growth: A definition

A pattern of regional development that:• protects and improves the quality of life for

all citizens• permits and promotes healthy behaviors• minimizes or eliminates hazards to people• protects, preserves, and restores the

natural environment

Smart growth is likely to feature:• Higher density, more contiguous development with

walkable neighborhoods• Preserved green spaces and other environmental

amenities• Mixed land uses• Limited road construction, balanced by transportation

alternatives (pedestrian, bicycles, mass transit)• Architectural heterogeneity• Economic and racial heterogeneity• Development and capital investment balanced between

central city and periphery• Effective, coordinated regional planning

A Public Health Approach to Sprawl

Issues to consider:• Enormous and growing interest among

policymakers and the public.• Possibility of “collateral benefits” of

interventions• The action is at the state and local level

The Intersection of Public Health and Sprawl

Potential loci of public health involvement:• Zoning decisions• Greenspace preservation efforts• Mass transit decisions• Design issues e.g. sidewalks• Watershed protection programs• Public education

Public health officials do not just work in the Health Department. They also include:

• Urban planners• Transportation engineers• Landscape architects• Developers• Lenders• Neighborhood activists

...and many others.